title: [Diagnosis and primary surgical therapy of anorectal abnormalities with regard to postoperative incontinence].
abstract: Aspects relating to diagnosis of anorectal agenesis are covered in this paper, with reference being made to the author's patients at the Cologne Department of Paediatric Surgery. Accurate preoperative diagnosis of both the type of malformation relative to anatomic pelvic floor structures and of possible concomitant malformations is considered to be the key to subsequent optimal continence. Proper choice of an anatomy-correlated, individual surgical approach is possible only on the basis of accurate analysis of the malformation concerned and its correct assignment and classification according to Wingspread or Rehbein. Optimum continence has proved to depend also on involvement of a surgeon with profound experience in and with all forms of anorectal malformations as well as on subtle approach accompanied by uninterrupted electrostimulation to identify muscular structures. Yet, even with all those prerequisites optimally satisfied, about 25 percent of all patients with severe anorectal malformations must be expected not to achieve continence. This may be attributable to one or several of the following causes: The muscular structures applied may be too hypoplastic and thus may fail to develop sufficient sphincter functionality. Postoperative management may be insufficiently careful and cause atrophy of muscle equivalents restored in the first place. Continence may be difficult or even impossible to achieve for concomitant sacral or urogenital malformations. Application of colostomy should be avoided in any case, and advantage should be taken, first of all, of all possible ways and means described in this paper for restoration of sphincter action.
authors.affiliation: Kinderchirurgische Klinik, Städtischen Krankenanstalten Köln.
authors.forename: A M
authors.initials: AM
authors.lastname: Holschneider
mesh_terms: D000465:Algorithms; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery
vernacular_title: Diagnose and primäre operative Therapie von anorektalen Fehlbildungen im Hinblick auf die postoperative Inkontinenz.